Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. RANTTAS Investigators.
OBJECTIVE
Medical and neurological complications after acute ischemic stroke may adversely impact outcome and in some cases may be preventable. Limited data exist regarding the frequency of such complications occurring in the first days after the ictus and the relationship of these complications to outcome. Our objective was to identify the types, severity, and frequency of medical and neurological complications following acute ischemic stroke and to determine their role in mortality and functional outcome.


METHODS
Rates of serious (life-threatening) and nonserious medical and neurological complications and mortality were derived from the placebo limb of the Randomized Trial of Tirilazad Mesylate in Acute Stroke (RANTTAS) database (n=279). Complications were correlated with clinical outcome using logistic regression techniques.


RESULTS
Of all patients, 95% had at least one complication. The most common serious medical complication was pneumonia (5%), and the most common serious neurological complication was new cerebral infarction or extension of the admission infarction (5%). The 3-month mortality was 14%; 51% of these deaths were attributed primarily to medical complications. Outcome was significantly worse in patients with serious medical complications, after adjustment for baseline imbalances, as measured by the Barthel Index (odds ratio [OR], 6.1; 95% confidence interval [CI], 2.5 to 15.1) and by the Glasgow Outcome Scale (OR, 11.6; 95% CI, 4.3 to 30.9). After death was discounted, serious medical complications were associated with severe disability at 3 months as determined by the Glasgow Outcome Scale (OR, 4.4; 95% CI, 1.3 to 14.8).


CONCLUSIONS
Medical complications that follow ischemic stroke not only influence mortality but may influence functional outcome.
Johnston
K C
KC
Department of Neurology, University of Virginia, Charlottesville 22908, USA. kj4v@virginia.edu
Li
J Y
JY
Lyden
P D
PD
Hanson
S K
SK
Feasby
T E
TE
Adams
R J
RJ
Faught
R E
RE
Haley
E C
EC
D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology; D019992:Databases as Topic; D004311:Double-Blind Method; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010919:Placebos; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011281:Pregnatrienes / Q000627:therapeutic use*; D012044:Regression Analysis; D012720:Severity of Illness Index
D018696:Neuroprotective Agents; D010919:Placebos; D011281:Pregnatrienes; C053355:tirilazad